Vitamin D status and prevalence of hypovitaminosis D in different genders throughout life stages: A Brazilian cross-sectional study

OBJECTIVES: To evaluate the mean concentration of 25-hydroxivitamin D [25(OH) D] and prevalence of hypovitaminosis D in individuals residing in Rio de Janeiro, Brazil. METHODS: The data of 80,000 consecutive individuals who had 25(OH) D measurements performed by electrochemiluminescence between 1/2/2018 and 2/5/2018 were selected. Patients who reported the use of therapies/supplements were excluded. Levels of 25(OH) D ≥20 ng/mL (ages <60 years) and ≥30 ng/mL (ages ≥60 years) were considered adequate. RESULTS: We analyzed the data of 24,074 individuals (1-95 years old, 64.7% female). Descriptive curves showed that, in both sexes, the mean values of 25(OH) D decreased from the first years of life until adolescence, then slightly increased, and then tended to stabilize during adulthood. Levels of 25(OH) D <20 ng/mL were observed in 6% of girls versus 3.6% of boys and in 13.6% of adolescent girls versus 12.6% of adolescent boys and 11% of adults. The percentage of seniors with serum levels of 25(OH) D <20 ng/mL was 13.6% in women and 12.7% in men; 53.2% of women and 50.6% of men had levels <30 ng/mL. CONCLUSIONS: Mean 25(OH) D values were higher in children and lower in adolescents and women. Approximately 90% of non-seniors and presumably healthy residents of the urban metropolitan region of Rio de Janeiro presented satisfactory levels of 25(OH) D during the summer months; however, in over half of the elderly, the serum concentrations of 25(OH) D were inadequate. Therefore, strategies for the prevention of hypovitaminosis D should be considered in the senior population.

Hemianopsia homônima como síndrome clínica isolada com alto potencial deconversão para esclerose múltipla / Homonymous hemianopia as an isolated clinical syndrome with high potential for conversion to multiple sclerosis

Introdução: A hemianopsia homônima ocorre apenas na presença de lesão retroquiasmática, sendo uma rara apresentação de doença desmielinizante. Objetivo: Relatar um caso raro de hemianopsia homônima como manifestação inicial de síndrome clinicamente isolada. Método: Foi realizada uma revisão de 809 prontuários médicos de pacientes com esclerose múltipla (EM) tratados no Hospital da Lagoa (Rio de Janeiro) entre 1995 e 2011, para identificação de casos de hemianopsiahomônima como manifestação inicial da doença. Relato de caso: Paciente do sexo feminino, 48 anos, apresentou em agosto de 2011 quadro de hemianopsia homônima esquerda incongruente associada à lesão em topografia do trato óptico direito, evidenciada na RM de crânio, que também revelou lesões periventriculares e em substância branca subcortical, compatíveis com doença desmielinizante. O exame do líquido cefalorraquidiano (LCR) revelou hiperproteinemia leve com síntese intratecal de IgG e IgM, e o estudo do potencial visual evocado mostrou comprometimento parcial das vias ópticas bilateralmente. Concluído o diagnóstico de síndrome clinicamente isolada, a paciente foi submetida à pulsoterapia com metilprednisolona, com remissão das queixas visuais e melhora acentuada do campo visual no segundo exame realizado. O diagnóstico de EM foi concluído em dezembro de 2011, com o resultado da segunda RM, que revelou redução no tamanho da lesão em topografia do trato óptico direito e persistência das lesões focais periventriculares e subcorticais, com o surgimento de novas lesões frontais captantes de contraste. Conclusão: Embora a neurite óptica seja a manifestação ocular mais frequente da síndrome clinicamente isolada, deve-se estar atento a outras formas atípicas de apresentação para que se possa fazer um diagnóstico precoce. Os defeitos de campo visual na EM geralmente têm bom prognóstico com o tratamento adequado...

Introduction: Homonymous hemianopia occurs only in the presenceof retrochiasmatic injury, being a rare presentation of demyelinatingdisease. Objective: To report a rare case of homonymoushemianopia as the initial manifestation of clinically isolated syndrome.Method: We conducted a review of medical records of 809 patientswith multiple sclerosis (MS) treated at Hospital da Lagoa (Rio de Janeiro) between 1995 and 2011, being found only one case of homonymous hemianopia as the initial manifestation of the disease. Case report: Female patient, 48 years old, presented in August 2011 incongruous left homonymous hemianopia associated with lesion in topography of the right optic tract evidenced in MRI, which also revealed lesions in periventricular and subcortical white matter, consistent with demyelinating disease. CSF revealed mild hyperproteinemia with intrathecal synthesis of IgG and IgM, and visual evoked potential study showed partial compromise of the optic pathways bilaterally. Completed the diagnostic of clinically isolated syndrome, the patient underwent pulse therapy with methylprednisolone, with remission of visual complaints and marked improvement of the visual in the second examination performed. The diagnosis of MS was completed in December 2011 with the result of the second MRI, which revealed a reduction in the lesion size in the right optic tract topography and persistence of periventricular and subcortical focal lesions, with theemergence of new frontal lesions uptake of contrast. Conclusion:Although optic neuritis is the most common ocular manifestation ofclinically isolated syndrome, we should be mindful of other atypicalforms of presentation so that we can make an early diagnosis. Thevisual defects in MS usually have a good prognosis with appropriatetreatment...